Pressure Ulcer prevention - 1000 Lives Plus

16th June 2010 An introduction to the SKIN Bundle and its implementation Presenter: Nigel Broad on Charge Insert name of presentation MasterNurse Slide Content Area Reduce the Percentage of Hospital acquired Pressure Ulcers(per

1000 patient days By 50% by 2010 Drivers Interventions Risk Identification Understand the risk factors for acquiring pressure ulcers Understand the local context & analyse local data to assess patients on ward/unit most at risk Utilise patient At risk cards to quickly identify those at increased risk Risk Assessment Assess pressure ulcer risk on admission for ALL

patients Re-assess skin every 8 hours where necessary Initiate and maintain correct and suitable preventative measures Reliable Implementation of the SKIN bundle Ascension healths initiative 2004 Identification, grading of pressure ulcers existing on admission /transfer & appropriate intervention Education Address these areas: Surface Keep Moving

Incontinence Nutrition Initiate and maintain correct and suitable treatment measures Utilise the local Tissue Viability nursing expertise Educate staff regarding the assessment process, identification and classification of, and treatment of pressure ulcers Educate Patients & family Develop patient information pack Baseline Assessments Hospital: Pressure ulcer Incidence 8-13% Pilot Ward (Anglesey): Baseline incidence rate - 4.5% Nutritional assessment - 50% Pressure risk assessment - 80% Source: spot audit March 08 An introduction to the SKIN Bundle and its Implementation

Preparation for Culture Change Set up multi - professional project team Staff Briefing and brainstorm Develop SKIN Bundle into communication tool Agree metrics Educate staff with TVN support Ensure PU prevention is given high priority e.g. team briefing, posters, visual cues Develop patient information leaflets Patient involvement is essential

An introduction to the SKIN Bundle and its Implementation What is the SKIN Bundle of care? Surface Mattress and Cushion Include safety checks Sheet checks, wrinkles etc. Reassess Waterlow score at least daily Keep Moving Reposition patient Inspect skin Encourage mobility Written advice for patient and carers

An introduction to the SKIN Bundle and its Implementation What is the SKIN Bundle of care? Incontinence Toileting assistance Continence products Seek specialist advice Keep clean and dry Nutrition Nutritional risk tool Follow instructions Ensure optimal intake Use of charts if required Keep well hydrated An introduction to the SKIN Bundle and its Implementation

An introduction to the SKIN Bundle and its Implementation Pilot SKIN Bundle Address risk scoring documentation set 100% compliance, daily review Deming's PDSA methodology commence with small client group: Model for Improvement Audit SKIN bundle communication tool daily Make it part of the ward fabric An introduction to the SKIN Bundle and its Implementation Outcome measures [Metrics] Document pressure ulcers of all grades (I IV) on Safety Cross Count days since last pressure ulcer developed on this ward and display on Safety Cross Incident form for any ulcer grade II and above

Calculate rate per 1000 bed-days Monthly audit compliance of risk assessments An introduction to the SKIN Bundle and its Implementation Safety Cross 1 2 3 4 5 7 8 9

10 11 12 13 14 15 16 17 18 19

20 21 22 23 24 25 26 27 28 Days since last PU ___ days

29 30 31 No new PU Ward acquired PU Patient admitted with PU An introduction to the SKIN Bundle and its Implementation Aim for success 100% compliance with risk score Manage the risk score consistently Use SKIN Bundle communication tool with

Patient involvement Written patient information and education leaflets An introduction to the SKIN Bundle and its Implementation It is now an adverse event! Pressure ulcer occurred on Jan 25th 2010 1. Grade 2 PU 2. Incident form filled in as per policy 3. Outcome - PU healed within 4 days 4. Critical analysis took place 1. Was patient assessed properly 2. Had assessment plan been maintained 3. Could something have been

done differently An introduction to the SKIN Bundle and its Implementation Keys factors to success Communication tool patient partnership Staff education and engagement all staff groups Model for Improvement Create a Culture of Change not just about a document Risk scoring and managing those scores Tissue Viability Nursing support Team approach with clear executive engagement An introduction to the SKIN Bundle and its Implementation Spreading the intervention Plan and manage using a multi-professional project team Use cycles of change when required

Quick wins are important success breeds success Give yourself clear aims that are SMART An introduction to the SKIN Bundle and its Implementation ANY QUESTIONS? An introduction to the SKIN Bundle and its Implementation

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